Canadian Psychiatric Association

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Guest Editorial
Eating Disorders
Paul E. Garfinkel
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In Review
Pharmacologic Treatment of Eating Disorders
April J Zhu, B Timothy Walsh
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Psychological Treatments for Anorexia Nervosa: A Review of Published Studies and Promising New Directions
Allan S Kaplan

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Original Research
Acute Psychiatric Inpatient Care for People With a Dual Diagnosis: Patient Profiles and Lengths of Stay

Philip Burge, Hélène Ouellette-Kuntz, Haider Saeed, Bruce McCreary, Dana Paquette, Franklin Sim

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Canadian Geriatric Psychiatrists: Why Do They Do It? A Delphi Study
Susan Lieff, Diana Clarke

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Relation of Blood Counts During Clozapine Treatment to Serum Concentrations of Clozapine and Nor-Clozapine
L Kola Oyewumi, Zack Z Cernovsky, David J Freeman, David L Streiner

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Research Methods in Psychiatry
Breaking Up is Hard to Do: The Heartbreak of Dichotomizing Continuous Data
David L Streiner

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Brief Communciation
Treatment Resistance in Anorexia Nervosa and the Pervasiveness of Ethics in Clinical Decision making
Chris MacDonald

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Topiramate Use in Obese Patients With Binge Eating Disorder: An Open Study
Jose C Appolinario, Leonardo F Fontenelle, Marcelo Papelbaum, Joao R Bueno, Walmir Coutinho

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Book Reviews

The Depressed Child and Adolescent. 2nd ed.

Clinical Assessment of Dangerousness: Empirical Contributions

The Feeling of What Happens: Body and Emotion in the Making of Consciousness

The Evolution of Psychoanalysis: Contemporary Theory and Practice

Psychiatrie gériatrique: esquisse d'une histoire médicale par l'élaboration de son langage

Démystifier les maladies mentales: les troubles de l'enfance et de l'adolescence


Books Received


Letters to the Editor

RE: Who Develops Severe or Fatal Adverse Drug Reactions to Selective Serotonin Reuptake Inhibitors?

RE: Canadian and American Psychiatrists' Attitudes Toward Dissociative Disorder Diagnoses

Acute Onset of Schizophrenia Following Autocastration

The World Trade Center Disaster

Selenium, Thyroid Hormones, Mood, and Behaviour

Book Reviews

General Psychiatry

Clinical Assessment of Dangerousness: Empirical Contributions. Pinard GF, Pagani L, editors. Cambridge (UK): Cambridge University Press; 2001. 286 p. US$59.95.


Reviewer Rating:
Review by Julio Arboleda-Flórez, MD, FRCPC, FAPA, DABFP, PhD
Kingston, Ontario


In 1878, Garófalo first introduced the concept of “temibilitá,” now known as dangerousness, to indicate constant propensity to violent action and the expectation that it will continue into the future. Since then, much has been written about whether governments have the right to impose penal sanctions for yet-to-be-committed criminal acts. Based on the doctrine of social defence, the state can ordinarily move to declare an individual dangerous and worthy of special security dispositions, once culpability has been established, and given either a past punctuated by similar actions or an act characterized by sadistic and unspeakable evil. This is a 2-stage process: the first is a simple (if any criminal investigation can ever be so) legal operation to prove authorship and culpability. Here, the players are the usually expected ones in criminal proceedings—the accused, the victim(s), the witnesses, the police, the lawyers, the prosecutors and the judges. The second stage, however, requires a complicated operation and an ensemble of extra players. These are usually experts at predicting and managing the risk the offender poses and will supposedly continue to pose to society. The operative words at this stage are “experts,” because they hail from areas of expertise outside criminology or law, and “supposedly,” because no matter what their knowledge, a claim to predict is fundamental to their involvement. In this respect, no amount of genetic-biological research, clinical acumen, or statistical-probabilistic modelling could or will provide 100% certainty that what the experts predict will in fact ever occur.

Predicting and managing risk is what this book is about. The editors’ excellent prologue presents a scholarly overview of the knowledge in the area. This is followed by 3 chapters on the basic issues of violence research: the biology of violence and the observation of violent behaviour and development of violent predispositions in the child. The rest of the book discusses specific issues, including violence pertaining to special populations or situations and violence prediction and management. These chapters deal with violence and mental disorders, violence and substance abuse, violence in family situations, and violence in regard to stalking and criminal harassment. Unfortunately, the book does not include a chapter on violence at the workplace—a major oversight given the multiple reports of violent behaviour, including shootings by disgruntled employees.

This meticulously edited and attractively bound book presents an up-to-date review of dangerousness and its assessment. The editors have assembled an impressive roster of collaborators to write the specific chapters. Many of them are well-known and first-kind researchers in their specific fields. Their excellent contributions and the presentation of the latest research findings in some chapters ensure the even quality of the book and make it extremely instructive. On the other hand, as the subtitle suggests, this is a book about the empirical contributions to the subject. It celebrates the empiricists, and as such, it presents an unbalanced and uncritical view of the science of divining dangerousness. Where does predicting and assessing dangerousness fit in the social universe? What are the legal implications of the doctrine of social defence that empowers governments to impose preventative detention? What ethical obligations flow to practitioners of the art, whose pronouncements will have dire outcomes for the freedom and sometimes the very lives of offenders? These questions are not explored. It appears that the editors have succumbed to a frenzy of knowledge and forgotten that theory drives practice—that social, legal, and ethical considerations should inform the debate and the use of empirical findings and that they ground whatever science has been amassed on the subject. Indeed, and sadly, this book has been written in a theoretical vacuum.

All in all, however, it contributes an empirical point of view to the burgeoning literature on these issues. It compiles the extant knowledge in the area and should be read by psychiatrists and mental health specialists engaged in predicting and managing violent behaviours.


Excellent   Good/    Fair/
Not recommended/
bon passable pas recommendé